Treatment for lymph node tuberculosis must be preceded by adequate pathological investigation of the lymphadenopathy

Among the numerous causes of lymphadenopathy, tuberculosis and lymphoma are both relatively common and potentially curable. The clinical features of tuberculous lymphadenitis overlap with those of lymphoma: some patients with each condition are asymptomatic apart from painless swelling, whereas others are unwell and have systemic symptoms such as fevers, weight loss, or night sweats. Accurate diagnosis depends on confirmation with appropriate pathology tests. We present three patients with lymphoma who were initially misdiagnosed as having tuberculosis. In each case this led to a delay in the treatment of the lymphoma, and in one case, chronic side effects from the unnecessary exposure to tuberculosis treatment compromised the treatment of the lymphoma. Lymph node biopsy and adequate histopathological assessment would have prevented these misdiagnoses and should be mandatory in suspected cases of lymph node tuberculosis when microscopy and cytology of fine needle aspirate does not show alcohol and acid fast bacilli, caseating granuloma, or granuloma with Langerhan’s cells.

Case 1

A 24 year old man was referred to a respiratory clinic with a four month history of lethargy, weight loss, and night sweats, together with a mass on the right side of his neck and a prominent right tonsil. More recently he had developed a cough and had had three episodes of green sputum. He was previously well and had no personal or family history of tuberculosis. He was born in the United Kingdom to Pakistani parents and received a BCG vaccination at school. He had visited Pakistan two years previously, and one year before presentation had come into contact with tuberculosis through his work.

Examination found a large neck mass (8 cm by 5 cm) but was otherwise unremarkable. A chest x ray three months before had been …

Get access to this article and to all of thebmj.com for 14 daysSign up today for a 14 day free trial